Background

The incidence and prevalence of end stage renal disease in Taiwan are on the top of the world according to United States Renal Data System 2018. When facing renal failure, patients are suffering from physical and psychological stresses due to lack of information. Shared Decision Making (SDM) is a process in which both the patient and physician contribute to the medical decision-making process. Case manager explain treatments and alternatives to patients and help them choose the treatment option.

Methods

From August 2018 to August 2019,all the patients, regular follow-up at the Nephrology outpatient department of E-Da hospital, with chronic kidney disease stage 5 eGFR≦10ml/min/1.73m² were enrolled. The nephrologist in charge gave explanations about renal replacement therapy, and then the patients were referred to education room for SDM education. he health educator explained the types of renal replacement therapy by using instruction materials, teaching aids, videos, bidirectional discussions, experience camps, in order to make patients fully realize dialysis(hemodialysis, peritoneal dialysis),kidney transplantation(living donation, cadaveric donation),and hospice care. The massages about education and discussion will be sent back to the doctor by computer systems, and the doctor could discuss with the patient further about the patient’s concerns. After SDM educations, the patients’ final decisions will be recorded.

Results

Total of 181 patients were enrolled and the decision before and after the SDM educations were compared. The number of patients with selection of hemodialysis was increased from 10 to 66, while with selection of peritoneal dialysis was increased from 9 to 53 after SDM. The patient number of decision-unmaking was significantly decreased from 160 (88%) to 59 (33%), McNemar chi-square test p<0.01. It shows that after the introduction of SDM, patients have more confidence to choose their treatment strategy according to their own will for renal replacement therapy.

Conclusion

It is so difficult to make a decision for renal replacement therapy when patients facing renal failure. An integrated team of physicians, case manager, nutritionist, and pharmacist can give individual health guidance. The application of SDM will extend more information and help patients to make a better decision.